HomeMy WebLinkAbout3540 Cameron Ave("A'10-7
CITY OF SANFORD PERMIT APPLICATION
Application # : 07— Z36 � ��/ Submittal Date:
Job Address: ���a Capt r0 & 4L'AQ_ _S0. d. !'�. 3z�i -) 1 Value of Work: S � 7� Loa . O �
Parcel ID:
Historic District:
Description of Work: L Ci t Square Footage: 4 Od d
Permit Type: Building ❑ Electrical ❑ Mechanical Plumbing ❑ Fire Sprinkler/Alarm ❑ Pool ❑ Sign ❑
Electrical: New Service - # of AMPS Addition/Alteration ❑ Change of Service ❑ Temporary Pole ❑
Mechanical Residential ❑ Non -Residential ,� Replacement ❑ New ❑ (Duct Layout & Energy Calc. Required)
Plumbing/ New Commercial: # of Fixtures # of Water & Sewer Lines # of Gas Lines
Plumbing/New Residential: # of Water Closets Plumbing Repair -Residential ❑ Commercial ❑
Occupancy Type: Residential ❑ Commercial X Industrial ❑ Occupancy Use Group(s):
Construction Type: # of Stories: J__ # of Dwelling Units: Flood Zone: (FEMA form required )
......................................................................................................................... A
Property Owner: G I TL b. �'J_6 ( Contractor: & i00- &QIQ �j _<-QXV i C T L
Address: Soo Al �f1S' �C ?y���-�- Address: -D 7 e_,t4e_W L1 r"
';�I 3J_')S-o
Phone: E-mail: Phone: o707_1 1 State License Number: dJ LD r 7 ! S-3
Bonding Company:
Address
Architect/Engineer: G
Address: J&a a GL•.
Plan Review Contact Person:
Mortgage Lender:
Address:
-+- Sac,'+V 14, 1'_-1
Phone: Fax:
Phone: V0") 3 ZZ 6 &"tl if
Q
Fax: YO%.3,10 0 41151
E-mail:
Application is hereby made to obtain a permit to do the work and installations as indicated. I certify that no work or installation has commenced prior to the
issuance of a permit and that all work will be performed to meet standards of all laws regulating construction in this jurisdiction. I understand that a separate
permit must be secured for ELECTRICAL WORK, PLUMBING, SIGNS, WELLS, POOLS, FURNACES, BOILERS, HEATERS. TANKS, and
AIR CONDITIONERS, etc
OWNER'S AFFIDAVIT: I certify that all of the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating
construction and Zoning.
WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAYING TWICE FOR
IMPROVEMENTS TO YOUR PROPERTY. A NOTICE OF COMMENCEMENT MUST BE RECORDED AND POSTED ON THE JOB SITE BEFORE THE
FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WTTH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR
NOTICE OF COMMENCEMENT.
NOTICE: In addition to the requirements of this permit, there may be additional restrictions applicable to this property that may be found in the public records of
this county, and there may be additional permits required from other governmental entitiesVP1ater manage t districts, state agencies, or federal agencies.
Acceptance of permit is verification that I will notify the owner of thef the re u' e ents of Florida Lien Law, FS 713.
Signature ofOwner/Agent Date Signature ofContractor/Agent Date
Print Owner/Agent's Namc Print ontractor/Ag it's Name /Q /� �]
A�(/tJ t. _ fl -M-4
/ - ! - " f
Signature of'Notary-State of Florida Date Signature of Notary -State of Florida �& .......................................
IAURA BARB
Comm# DD0709758
44
�r Expires 8/28/2011
Florida Notary Assn., Ini
O%vner/Agent is _ Personally Known to Me or Contractor/Agent is Personally Known to Me,4i.....u.a.•.....•.......................
Produced ID _ Produced ID
APPROVALS: ZONING:
Special Conditions:
Rev 07.07
UTIL: FD:
ENG: BLDG: